Director, Provider Network Operations

Job not on LinkedIn

🕒 October 20

🇺🇸 United States – Remote

💵 $108.5k - $184.4k / year

⏰ Full Time

🔴 Lead

🌐 Network Operations

👻 Ghost score 20%

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PacificSource Health Plans

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1933

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

PacificSource Health Plans is a healthcare provider that offers a range of health insurance solutions, including plans for individuals, families, and employers. Their offerings include Medicare and Medicaid plans, dental coverage, and administrative services for small and large groups. Committed to member care, PacificSource emphasizes customer service and provides various resources for health management, including mental health support and wellness programs.

📋 Description

• Oversee Provider Network divisions including Provider Relations, Provider Data Management, Credentialing, and provider platform interoperability • Guide strategic initiatives for network setup and maintenance, provider data integrity, provider education and service, contract implementation, provider-related claims, audits, corrective action plans, and directory accuracy • Collaborate with reimbursement insights and analytics teams to meet objectives • Direct Credentialing division efforts for compliance and operational excellence • Develop strategies for provider education, relationship management, collaboration, engagement, and satisfaction • Lead integration and operational effectiveness of provider network platforms with legacy and emerging systems • Partner with software vendors, IT teams, operational leaders, and internal stakeholders to improve interoperability and streamline operations • Ensure systems support state, federal, and NCQA standards and organizational policies • Develop automated workflows and improve functionality using LEAN methodologies • Participate in strategic planning, execution, resource allocation, and performance monitoring • Work with executive leadership on processes, technology, people resources, performance metrics, and efficiency targets • Oversee provider collaborative efforts and guide functional leaders in developing business plans • Design and deliver provider education programs and address provider feedback • Collaborate with Operations, IT, Health Services, Analytics, Finance, and other departments • Oversee annual IT work plans, initiative work plans, financial budgets, and resource needs • Develop coaching and training programs; oversee resource prioritization and competency development • Hire, develop, coach, and evaluate staff and enhance employee engagement • Oversee division budgets and spending and take corrective action as needed • Assess innovative provider payment methodologies for approval and implementation • Participate in manager/supervisor meetings, PRISM walks, internal committees, and department activities • Follow privacy policy and HIPAA requirements; perform other assigned duties

🎯 Requirements

• Minimum of 8 years of experience in a leadership role overseeing healthcare provider network operations or related functions • Experience leading at least two of Provider Relations, Credentialing, and Provider Data Management strongly preferred • Demonstrated experience managing large, multi-level teams and complex operational portfolios • Knowledge of provider reimbursement methodologies, provider network operations, compliance requirements, and healthcare data management • Experience developing and executing strategy within a matrixed organization preferred • Bachelor’s degree in business, health care administration, finance, or related field required • Candidates with an associate’s degree and 2 years of relevant experience, or a high school diploma and 4 years of relevant experience, in addition to the required minimum years of work experience will also be considered • Advanced knowledge of provider reimbursement and reimbursement methodologies, provider relations, or provider partnership activities in relevant markets and geography • Ability to lead people in a matrixed organization structure and build high performing teams • Proven collaborative interaction experience with provider leaders • Ability to read and comprehend both written and spoken English • Communicate clearly and effectively • Ability to stoop and bend, sit and/or stand for extended periods, perform repetitive motions, and lightly lift and carry files and business materials

🏖️ Benefits

• Equal opportunity employment • Travel approximately 15% of the time • General office setting with ergonomically configured equipment • At-will employment

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